participants. Each of the following components is essential to address in applying the criterion.

Health and Weight Status Healthy weights are generally associated with a BMI of 19–25 in those 19–34 years of age and 21–27 in those 35 years of age and older (USDA and DHHS, 1990). However, individuals with a BMI of 25–27 are at slight risk from obesity if they have no comorbidities and at moderate risk if they do (see Figure 2-6). Beyond these ranges, health risks increase as BMI increases. Health risks also increase with excess visceral fat (waist-to-hip ratio [WHR] >1.0 for males and >0.8 for females), high blood pressure (>140/90), dyslipidemias (total cholesterol and triglyceride concentrations of >200 and >225 mg/dl, respectively), non-insulin-dependent diabetes mellitus, and a family history of premature death due to cardiovascular disease (e.g., parent, grandparent, sibling, uncle, or aunt dying before age 50). Weight loss usually improves the management of obesity-related comorbidities or decreases the risks of their development.

Psychological Status Psychological status can be assessed by using the tools listed in Appendix A. At this time, we recommend that prior to beginning a weight-management program, all individuals take the Dieting Readiness Test (discussed in Chapter 6 and presented in Appendix B) or some comparable test, which can be administered and scored by the individual or appropriate staff at a nonclinical program. Such a test helps to point out potential problems with motivation and attitudes toward dieting and exercise. Clinical programs should also administer the General Well-Being Schedule (also discussed in Chapter 6 and presented in Appendix B) or a comparable test to identify frank psychological pathologies (e.g., depression) and determine whether an individual should be referred for more in-depth psychological assessment before beginning the program.

Diet Consumption of a calorically modified diet containing a variety of foods is required for long-term weight management in individuals with or tending toward obesity. For practical purposes, we define a good dietary pattern as one in which the individual meets the Food Guide Pyramid guidelines on at least 4 of 7 days. A few nonclinical but many clinical programs put their clients on diets that are based on the use of special nutritional products and dietary supplements; this is generally appropriate during the treatment phase but is often difficult to sustain for long periods of time. Decreasing total energy intake and the consumption of dietary fat, sugar, and alcohol, while providing adequate nutrients, dietary fiber, and protein to maintain nitrogen balance and limit the loss of lean body mass, is a time-tested way to lose weight safely.

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